Findings from a recent study published in Eye assessed the long-term outcomes following rhegmatogenous retinal detachment (RRD) repair.
Give me some background.
RRD requires prompt intervention to avoid vision loss, with the procedures listed as the most common interventions:
- Pars plana vitrectomy (PPV)
- Scleral buckling (SB)
- Combined vitrectomy-buckle
- Pneumatic retinopexy
While these procedures have relatively high anatomical success rates (80-90%) in uncomplicated cases, functional and visual outcomes can be more difficult to predict.
Also of interest: Macula-off detachments are known to lead to poorer visual outcomes compared to macula-on detachments
- It is generally understood that the duration of macular detachment before repair is an important prognostic factor in the visual outcome.
Bring it back to this study.
However, the study authors noted a lack of long-term prospective data to describe long-term visual outcomes following retinal detachment repair.
To address this issue: Investigators utilized data from the Scottish Retinal Detachment Study (SRDS), a prospective population-based study that recruited 96% of incident cases of RRD in Scotland over a 2-year period.
- Data collection was completed 10 years ago, providing a large, inclusive patient cohort from which population-level inferences can be drawn.
Now, talk about the study.
In this retrospective study, investigators analyzed 10-year patient data after RRD repair during the original SRDS.
- Patients were excluded if they did not have 10-year follow-up data or if they had significant comorbid ophthalmic disease.
In total, 103 patients had best-corrected visual acuity (BCVA) outcomes for at least 10 years postoperatively and met the inclusion criteria.
- Note: Of these patients, 57 were macula-on and 46 were macula-off.
Findings?
The median 10-year BCVA was 20/25 and the 10-year BCVA was significantly better in macula-on patients compared to macula-off (20/20 vs. 20/30, respectively, p<0.001).
There was a significant improvement in macula-off BCVA from short-term follow-up to 10-year BCVA (p=0.04).
Of note: 93% of macula-on patients achieved BCVA sufficient for United Kingdom (UK) driving standard (< 20/40) compared to 65% of macula-off patients.
Anything else?
After the 10-year follow-up period, the lens status of patients was as follows:
- Phakic: 34 patients (87 preoperatively)
- Pseudophakic: 65 patients (13 preoperatively)
- Aphakic: 4 patients (3 preoperatively)
Other observances:
- There was no difference in 10-year BCVA between RRD repair techniques
- Redetachment occurred in 14% of patients and conferred a poorer 10-year BCVA (20/40)
Expert opinion?
Only 9.8% of patients who underwent vitrectomy for RRD remained phakic after 10 years.
This highlighted how “the likely need for subsequent cataract surgery is an important part of the consent process for retinal detachment repair with vitrectomy, especially if the patient is aged over 50,” investigators explained.
Limitations?
The study authors identified the main limitation of this study as the attrition bias inherent to any long-term follow-up study.
They added that using “duration of central vision loss” as a proxy for “days of macula detachment” may have introduced recall bias—as these two are not necessarily equivalent in all patients.
Take home.
These findings suggest that long-term BCVA remains good following successful macula-on RRD repair, with almost all macula-on and most macula-off patients achieving the UK VA driving standard.
Macula-on detachments had significantly greater long-term VA than macula-off detachments, and redetachment was uncommon but conferred a poorer long-term visual outcome.